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Informed Health Online [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-.

Informed Health Online.

Types of insulin therapy

Last Update: October 23, 2013.

The aim of insulin therapy in diabetes is to make up for the lack of insulin in the body, to lower blood sugar levels, and prevent long-term complications as best as possible. It is important to not allow blood sugar levels to get too high or too low. There are different types of insulin therapy.

Blood sugar (glucose) levels are not only affected by the amount of insulin you inject but also by what you eat and drink, as well as how much energy you use during physical activity. The time of day, inflammatory diseases, other medications and hormonal changes can influence your blood sugar levels too. This means that people with diabetes have to be familiar with their own body and their own personal habits so they can adjust their insulin therapy accordingly.

You can find more information on this topic in our feature.

There are various types of insulin. These mainly differ in how long their effect lasts. Some types of insulin cover the basic needs of your body: they work slowly and constantly over half a day or a whole day (intermediate-acting or long-acting insulin). “Short-acting” insulin is used at mealtimes to provide the insulin needed after eating. It is used in addition to longer-acting insulin.

Nowadays people who have diabetes can largely decide for themselves which of the different types of insulin therapy they would like, to make sure it fits into their daily lives. Most people with type 1 diabetes choose “intensive” insulin therapy.

Conventional insulin therapy

Conventional insulin therapy involves injecting insulin twice a day. This approach is often chosen by people who have a fairly regular daily routine and prefer to inject their insulin at the same times every day.

The basis of conventional insulin therapy is formed by intermediate-acting or long-acting insulin that works for at least half a day. This type of insulin can either be used alone or together with short-acting insulin. Most people use a standard mixture of short-acting and longer-acting insulin. They inject this mixture once before breakfast and once before their evening meal. In order to compensate for the effect of insulin, they have to eat fixed amounts of food regularly over the course of the day. People who do a lot of physical exercise can make up for it by eating extra snacks between meals. So, with conventional insulin therapy, meals and physical exercise are planned around the insulin.

Choosing conventional insulin therapy can mean leading a fairly regimented lifestyle. And, compared with intensive insulin therapy, conventional insulin therapy is much less effective at preventing complications associated with type 1 diabetes. So most people who have type 1 diabetes choose intensive insulin therapy instead. Conventional insulin therapy is usually only considered if intensive insulin therapy is not possible.

Intensive insulin therapy

In intensive insulin therapy, the amount of insulin can be adjusted flexibly and spontaneously based on a person’s blood sugar levels, how much they eat and how physically active they are. Regular blood sugar monitoring is essential here. You can either inject yourself with insulin several times a day or use a pump to deliver it. To cover your basic insulin needs, longer-acting insulin can be injected once or twice a day. This is often called “basal insulin.” Short-acting insulin is injected before meals to deal with the carbohydrates that are eaten. This is known as a “bolus dose” or “mealtime insulin.”  

People who have an insulin pump only use short-acting insulin. The pump regularly delivers small amounts of insulin to continuously cover the basic needs of the body.

One goal of intensive insulin therapy is to reach almost normal blood sugar levels. It also aims to allow people to be flexible and spontaneous in their everyday lives. There is no need to eat meals at fixed times or make sure you always eat the same amount of carbohydrates. Instead, you inject as much insulin as you need at the time. The amount of insulin needed will also depend on your blood sugar levels, the time of day and whether you plan to be physically active. If you inject too much insulin, your blood sugar levels may drop too low. If you inject too little, they may be too high.

Intensive insulin therapy has been shown to have health benefits over conventional insulin therapy. It can lower the risk of developing diabetes-related complications, particularly those affecting the eyes, kidneys, nervous system and heart.

Patient education programs

People who need insulin have to learn various skills, like measuring their blood sugar. In Germany there are education programs to help people manage their diabetes. These are offered as a part of the disease management programs (DMPs) for type 1 and type 2 diabetes. Here people learn how to best attune their diet, sports and other physical activities to their insulin therapy and other blood-sugar-lowering medications.

The aim of modern diabetes treatment is to coordinate normal daily activities and the self-management of blood sugar as effectively as possible, while making the best use of medical care, including medication. People who are well informed about their diabetes, and follow their treatment plan properly,  can avoid associated complications and be as flexible as people who do not have diabetes.

Published by the Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

Next planned update

October 2016. You can find out more about how our health information is updated in our text "Informed Health Online: How our information is produced."


  • IQWiG health information is based on research in the international literature. We identify the most scientifically reliable knowledge currently available, particularly what are known as “systematic reviews.” These summarize and analyze the results of scientific research on the benefits and harms of treatments and other health care interventions. This helps medical professionals and people who are affected by the medical condition to weigh up the pros and cons. You can read more about systematic reviews and why these can provide the most trustworthy evidence about the state of knowledge in our information “Evidence-based medicine.” We also have our health information reviewed to ensure medical and scientific accuracy.
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